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Click ‘Get Form’ to open it in the editor.
Begin by filling out Section 1, Applicant Information. Select whether you are a Retired Employee, Widow(er), or Child. Enter your Name, Social Security Number, Phone Number, Address, City, State, Zip, and Email.
Indicate how you will provide account information by selecting one of the options regarding a voided check or a bank letter. Ensure you read and accept the terms of the agreement.
Sign and date the form in the designated areas to authorize MEABF for direct payments.
If applicable, complete Section 2 for Joint Account Holder(s) Information by providing their details and signatures.
In Section 3, Financial Institution Certification, circle the type of account (Checking or Savings) and have a bank officer complete their section with their signature and date.
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